Shh… Just Whisper it, But There Might Just Be a Revolution Underway

The idea that our more distressing emotions can best be understood as symptoms of physical illnesses is a pervasive, seductive but harmful myth. It means that our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change in how we understand mental health problems and in how we design and commission mental health services.

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It’s all too easy to assume mental health problems must be mystery biological illnesses, random and essentially unconnected to a person’s life. But when we start asking questions about this traditional ‘disease-model’ way of thinking, those assumptions start to crumble. While it obviously serves the purposes of pharmaceutical companies, ready with their chemical pseudo-solutions, the evidence doesn’t support this view.

Some neuroscientists have asserted that all emotional distress can ultimately be explained in terms of the functioning of our neural synapses and their neurotransmitter signallers. But this logic applies to all human behaviour and every human emotion – falling in love, declaring war, solving Fermat’s last theorem. It clearly doesn’t differentiate between distress – explained as a product of chemical ‘imbalances’ – and ‘normal’ emotions.

It is helpful to understand more about how the human brain works, but bio-reductionist accounts of mental health problems seem rather unhelpful. It’s obvious that neural activity and chemical processes in the brain lie behind all human experiences, but this is very different from assuming that some of those embodied experiences should be classified as illnesses. Our biology provides us with a fantastically elegant learning engine. But we learn as a result of the events that happen to us – it’s because of our development and our learning as human beings that we see the world in the way that we do.

Critics of traditional psychiatric thinking have begun to question the creeping medicalisation of normal life, and to criticise the poor reliability, validity, utility and humanity of conventional psychiatric diagnosis.

Over the past twenty years or so, we’ve seen a very positive and welcome growth of the user and survivor movements, some first signs of more responsible media coverage, and a rejection of the idea that we should be stupefied by shame and stigma into accepting the paternalism of earlier days – we are just starting to see the beginnings of transparency and democracy in mental health care.

Reviews of the ineffectiveness and adverse effects of many psychiatric drugs as well as of the effectiveness of evidence-based psychological therapies have led many to call for alternatives to traditional models of care.

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All this has led many to call for radical alternatives to traditional models of care. I agree. But I would argue that we do not need to develop new alternatives. We already have robust and effective alternatives… we just need to use them.

We need to place people and human psychology central in our thinking. And we need to return to core principles – ethical, professional and scientific.

Psychological science offers robust scientific models of mental health and well-being. These integrate biological findings with the substantial evidence of the social determinants of health and well-being, mediated by psychological processes.

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We must move away from the ‘disease-model’, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognises our essential and shared humanity.

Our mental health is largely dependent on our understanding of the world, our thoughts about ourselves, other people, the future, and the world. Biological factors, social factors, circumstantial factors – our learning as human beings – affect us as those external factors impact on the key psychological processes that help us build up our sense of who we are and the way the world works. This is diametrically opposed to the traditional ‘disease-model’ of mental illness.

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I believe the time is right to offer a radical new ‘manifesto’ for mental health and well-being.

I believe that services should be based on the premise that the origins of distress are largely social. The guiding idea underpinning mental health services needs to change from assuming that our role is to treat ‘disease’ to appreciating that our role is to help and support people who are distressed as a result of their life circumstances, and how they have made sense of and reacted to them.

This also means we should replace ‘diagnoses’ with straightforward descriptions of problems. We must stop regarding people’s very real emotional distress as merely the symptom of diagnosable ‘illnesses’. A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and for the design and planning of services.

Our health services should sharply reduce our reliance on medication to address emotional distress. We should not look to medication to ‘cure’ or even ‘manage’ non-existent underlying ‘illnesses’.

We must offer services that help people to help themselves and each other rather than disempowering them: services that facilitate personal ‘agency’ in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions. Where individual therapy is needed, effective, formulation-based (and therefore individually tailored) psychological therapies should be available to all.

When people are in acute crisis, residential care may be needed, but this should not be seen as a medical issue. Since a ‘disease model’ is inappropriate, it is also inappropriate to care for people in hospital wards; a different model of care is needed.

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Adopting this approach would result in a fundamental shift from a medical to a psychosocial focus. It would see a move from hospital to residential social care and a substantial reduction in the prescription of medication.

And because experiences of neglect, rejection and abuse are hugely important in the genesis of many problems, we need to redouble our efforts to address the address underlying issues of abuse, discrimination and social inequity.

This is an unequivocal call for a revolution in the way we conceptualise mental health and in how we provide services for people in distress. But I believe it’s a revolution that’s already underway.

Peter Kinderman is Professor of Clinical Psychology at the University of Liverpool, an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust, and Vice President of the British Psychological Society. His research interests are in psychological processes as mediators between biological, social and circumstantial factors in mental health and wellbeing. His most recent book, ‘A Prescription for Psychiatry’, presents his vision for the future of mental health services. You can follow him on Twitter as @peterkinderman.

33 COMMENTS

Excellent article. What do you think of Soteria? Also, there is a residential program in Sweden I recently heard about on alternative radio, but I don’t remember the organization. Do you know the program I’m talking about? People with supposed “psychosis” are put with families and both the person and the family are supported by therapists.

Hi, thank you Peter for an inspiring and important article. Just to add that our work place Family Care Foundation is actually not an offshoot from Open Dialogue even though we share many essential ideas and values.

“It clearly doesn’t differentiate between distress – explained as a product of chemical ‘imbalances’ – and ‘normal’ emotions.”
Exactly. Same with fMRI studies – depressed people have different brain activity: wow, congratulations Sherlock. So do tired vs active people or people who are in love and not in love or people who suffer from pain and those who don’t or who feel hungry or have just eaten…
Chronic stress (especially social) and trauma seem to be the most relevant factors in development of almost any kind of psychiatric “disease” and if there are any genetic components their contribution is barely if at all significant and usually linked to stress pathways anyway.

Know that, been there. But that’s a legitimate medical issue to be dealt with by the real doctor – I have yet to meet a psychiatrist who would do as much as to order a blood check to look for low iron levels etc. (well, in fact they did one one me, involuntarily, in the hospital because they were required to do so and then happily ignored it altogether).
In fact psych meds can cause/exacerbate these problems – I never had any issues due to low iron levels before I got on dopamine antagonists when I developed restless leg syndrome. Iron has sort of cured me from it (sort of – it still comes back occasionally and then I have to take more supplements – it’s bullshit that RLS stops as soon as you stop the drug, never believe that).

I wasn’t on any medication when I had the iron deficiency that I thought was depression, my psychiatrists called it “retarded depression.” I had been vegetarian for a while and wasn’t eating well because I didn’t have a kitchen— my diet was inadequate. Oh, if I had seen a doctor first AND boy I like where I am now can both rest together in my mind. That the whole field has too much power, too little evidence, and does too much harm, bothers me most.

Well, I also had my iron deficiency (very slight one, actually it was still considered lower normal range on a blood check) also due to a combination of being a vegetarian and not eating properly due to stress. But the RLS symptoms didn’t show up until I was not put on drugs which interfere with dopamine signalling. Dopamine signalling requires iron so I guess my brain was trying to compensate but couldn’t because what has been sufficient iron for me stopped being sufficient with the drugs. It took me almost 2yrs to get it back to normal with supplements and I took drugs only for a very short time. I can only imagine how screwed up is the metabolism of a person who is on these drugs for years…
But sure, just straight iron deficiency with no drugs attached can also cause a lot of problems.

Great post Peter and thanks for joining the conversation. I agree we have shifted to medicalizing and pathologizing much of human experience and then primarily relying on psych drugs to “fix” the problem.

I think much of the shift has been due in large part to economics. Many people labeled with chronic “mental illness” only get to periodically see prescribers and a case manager. Medicare doesn’t pay for individual counseling for these folks but will happily pay for a haldol decanoate shot, etc.

I think some of the key to this is to shift to peer based free “counseling”, similar to the 12 step path but not based on a disease DSM medical model.

I also agree with Wiley here that the physical experience of distress needs to be looked at as well, that emphasizes nourishment over drugs.

When I tell a normal person that I have a ‘diagnosis’ they usually ask me about the background. I recovered because I stopped taking medication carefully, and got the help I needed from practical psychotherapy.

When I tell a doctor about my history, the doctor usually avoids the background, and records ‘diagnosis’ as fact. He/She can’t cope with reality.

Excellent article. Thanks, Peter. There is an urgent need to shift to recovery-based care. Places like Connecticut and Philadelphia have shown the positive changes that can occur with such a shift. We need to advocate for such change within the ‘industry’ and general population and empower people more, to deal with their problems and help each other.

Anyway as an activist in this revolution I accept that it’s ending with a whimper not a bang as much as I would like to see a really big bang like the whole psychiatric industry put on public trial for it’s crimes against humanity, its obviously not going to go down like that.

Just a whimper as more and more people slowly come across truth and start reading

This is an excellent post and I greatly appreciate it. I feel increasingly demoralized to see new “studies” about the supposed 108 genes associated with schizophrenia or the supposed genes associated with all the 5 major “mental illnesses” like the latest fad fraud bipolar that is used for serial killers, domestic violence/rape victims and other absurdities. It was well known this was a garbage can stigma by the creators of DSM III led by the malignant narcissist Robert Spitzer when psychiatry sold out to Big Pharma because Freudian analysis was waning.

Thus, your latest post is very positive and hopeful. You talk about a growing revolution. I hope you write another post soon explaining any such gains in sanity despite the insanity of the biopsychiatry/Big Pharma/Government Industrial Complex. Yet, the NIMH in the U.S. under the ongoing ideology of Dr. Thomas Insel and his cohorts are much enthused about his big brain and other bogus blaming the brain projects. There was some hope when he admitted that DSM stigmas are invalid in the article, Transforming Diagnosis, on his NIMH blog, but it’s back to business as usual with the latest bogus gene claims for bipolar and schizophrenia touted by Insel and his cohorts. It doesn’t look too promising in the U.S. for sure given this agenda. One positive thing I’ve read is that many experts have been fighting the great brain project in Great Britain. Have you been part of that?

I look forward to reading more of your great, uplifting posts in the future.

If the “disease model” is inappropriate, so is the concept of “mental health.” Why use one while critiquing the other when they are mirror reflections? When one talks about getting rid of the “medical model of mental illness” she/he is conferring legitimacy upon the term “mental illness,” hence embracing the medical model.

Best of luck with your new book, I do agree with the majority of your sentiments. Thank you for speaking with common sense. I will say, however, that it seems many of the psychologists in the US (for example, two whose views I know well, the one who misdiagnosed my withdrawal symptoms of a “safe smoking cessation med” as “bipolar,” and a subsequent friend I volunteered to help children with) seem to be completely brainwashed by belief in the DSM “diagnoses.” I do hope the British psychologists can help the US psychologists garner some insight into common sense and reality, some day soon.

And I must confess, I don’t agree it’s logical to “assume ‘mental health problems’ must be mystery biological illnesses, random and essentially unconnected to a person’s life.” But, I do know such completely illogical assumptions did make an “ass” out of all the psychiatric practitioners I’ve ever worked with, and “me.” But, I guess you claimed it was an “easy” assumption, with “easy,” albeit extraordinarily detrimental “cures” for what are likely most often completely iatrogenic and “non-existent” diseases.

But, I personally, was not brought up to believe it was either wise, or classy, to be “easy.” But doing what is “easy” (money) seems to be psychiatry’s mantra. Well, that, and being completely unethical whores for money, for grotesquely immoral and downright disgusting reasons. I hope the psychologists can take back some turf, because the psychiatrists have lost their minds with their new found power. Power corrupts, and at least the psychiatrists working in the US, are at the point of absolute corruption.

I seriously doubt a revolution is on its way. After all, we just went through an era where many providers and state mental health agencies asserted no less then wholesale transformation. Earlier eras promised best practices, evidence best practices and treatment predicated on the principles of recovery and wellness without evidencing material change.

When someone can provide empirical evidence that the revolution is here I’ll believe it. Until then I can only believe “what is” rather then “what is hoped for.”

I agree Joe. Regular reading Mad in America might one give the impression that a revolution is underway, but when I look what’s happening in my city I don’t see a revolution happening anytime soon. Quite the opposite, the medical model seems stronger than ever. But that is only my interpretation and I could be completely wrong. So yeah, where is the evidence?

I agree with the both of you. The media claims controversy concerning the revising of the DSM in a story I read recently. Really?

NIMH director Thomas Insel objects to the DSM because it is not science. Duh. He though thinks there are bio-markers that research is going to reveal. Insel’s objection then, in a sense, amounts to saying the DSM is not biological enough. We’ve hardly lost the bio-reductivist narrative in his case, and if he gives a little on psych drugs in certain instances, he takes it back in the next breathe. Technology, gizmos and gadgets, are going to effect this “revolution” he’s got in mind, but his would be a bio-reductivist “revolution” [sic].

Allen Frances, in the spotlight for chairing the DSM-IV revision committee, is posing as the mainstream media’s number one of critic of the DSM-5. He’s playing two sides against the middle. He will be getting cozy with an ex-patient advocate one day, and on the next he is flirting with E. Fuller Torrey, and his Treatment Advocacy Center cronies, you know those folks lobbying for more and more forced drugging.

The government is targeting children and adolescents in it’s effort to appear to be doing something about violence in this nation. The government would have people believe that by labeling and drugging people it is doing something about violence. Violence it is blaming on people in the mental health system, and fundamental to the ‘insanity defense’ that gets people into the system is the idea that these violence acts are the product of “disease”, and that this “disease” is “biological”. Anybody that alludes to the drugs directly as a potential cause for much of the damage we see today in mental health treatment tends to be looked at suspiciously in mainstream mental health circles, and often will find themselves dismissed as “anti-psychiatry”.

I also see some good where approaches that don’t employ psych drugs so much, like Open Dialogic practices, are being introduced. The problem is that the mental health system, the whole psycho-pharmaceutical industrial complex, is expanding so fast as to make those little gains hardly more than a drop in the bucket, and in so far as the situation as a whole is concerned, negligible.

The problem is that there isn’t a lot of health in “mental illness” the business but, just the same, that ‘illness’ business keeps a lot of people in work. “Wellness”, except tongue in cheek, and there’s a heck of a lot of that, isn’t profitable, not by the vultures who live off other people anyway and, in actuality, it doesn’t require its own “service industry”. It’s difficult to imagine that we could be getting a lot closer to the kind of paradigm change that we so desperately need, given what’s going on now.

Some very wise revolutionaries with whom I am familiar have a saying: “The power of Truth is final.” It doesn’t matter how many people the medical model holds sway over. Since it is rooted in fraud and falsehood it is onl;y a matter of time until it is exposed and held in ridicule.

Revolution is a powerful word and should not be used flippantly. There can and will be no “revolution in mental health care,” other than the complete dismantlement of the “mental health” gulag. But I also recognize something else going on here, which is called cynicism. It is reflected in the idea that “revolution” is someone else’s job, and the conclusion that since one can see no “evidence” of change in his/her particular microcosm that such change is impossible, or at least very distant.

This sort of attitude discourages fundamental change, and I wonder if this is the actual intent of those who make such bleak pronouncements.

I’d like to rephrase part of my last comment. While it is absolutely my opinion that standing back and judging others’ efforts at making fundamental change is all too easy, my apologies for the implicaction that the pessimism reflected in the above post(s) is any sort of conscious effort to spread cynicism. I thought I was responding to a different person.

I have read the reactions, to this post, and I agree that there is a need for action, against psychiatry. While I believe that it is a good idea to write and publish challenges to their lies and prevarications. I don’t believe that this is enough, because basically those that consume services, don’t believe they have alternatives and also the psychiatric model of treatment is accepted by the public because it is aligned with the medical model of care.

I believe that if we continue to purse this course, change will be slow, and people will continue to suffer needlessly. Simply because we are not seen as authority figures, and the public looks to those authority figures for validation.

However there are good counter authority figures. A good examples is Dr. Petter Breggin. His testimony in law suits against psychiatric medicines, are important, though not widely known by the public. I think ti would be important to reach out and organize professionals who understand how harmful the current system is.

I think it could also be important to seek legal help, and pursue qui tam lawsuits against pharmaceutical companies, insurance companies, and psychiatric providers who knowingly damage people with harmful treatment and care. This could also increase resources for future legal actions, challenges and providing high profile information to protect the public.

Another focus should be identifying political leaders who support reform, and those that are against it.

Part of the reason psychiatry gets away with murder is because, its done in secrecy, hidden behind psychiatric jargon that the public doesn’t understand, and people feel they have not place to turn to.

Most people don’t even know the difference between a Psychiatrist, Psychologist, LPC, or an LCSW.